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P N E O R ACh nLC((4
DE PAR TMEIJT OF dUtLDf?\10 INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01000
wore{L>zs co� PrNS,TZON MSUrANCE �FFH) ��`�T
v),rlth a principal plat- Of busi1)esslresidencc at
J;honC�=�--.
do hereby certify, under the pins 1-,nd pen2_ities of perjury, 1121
( ) [ am an empioyc; providing the iolI( ,'inr for my
LIUp�OvCeS «'O[ 1114 on lhls Jos
(1IlS17SW]G^ �O[�I;:_li�) IhC!lL 1 l_Litr_r)
1 2m 2 sole prODiC?01 i eile:<: C-0niTcC'Oi nOn1e0'y'Tie: (C ;e On` ) 1U lc 'e hu(ed
the contractors lister bc)ov�,, vYLo the :�ollo:��_: �t�orf.e�s cocoensation policies
('Nanic Of
of COLi7EC101) (insurance Corlpa ',/PO�)C' titu�c�r)- {t :nir:lion D2te)
— — --- ------- — --
(Name of Contractor) (Insurance Compan)-/Police N,tmbcr) (Expirtion Dale)
-- ---------- -------- —— -----
(Name of Conn-acior) (11suranc-- CompaIIy/policy Numb,--J) Date)
(acat�ad.iriiocal z'xd:f nccr-u�-,:to �ncJ'uc�ia.�orv��=i oo pctz�:ir to ill om'r,.r_o:�)
O I am a sole proprietor and have no one worL� ng for me-
I am a home owner performing all rile work Myself
NOT -s wnc
E:plcc be awa2 Uiui ,,bJo bomcun wbo-.play Vc-,Qm w 6�m =1z c-�a
oo cr ru worx on d.,<Il ng of
oo( cc mo th=n thn units in u-t' h tl),c bom-a-n—r,=do oc oa(bc gou� t',be
employ—under the --p-:as i co Ac((GL152--1(5)�nWI-u=non by n homnowDa for e lian�c oc pcnnit lnay cvr6cacc the
lcipl c ulun of an cwployx undo dro Work et Compooi.lion Act
I undcro a d th,d a copy of(hij Ma—cm m y bo to tbo Dovo t,—a of ln&i d Amdcu (DfG o or L,, foc tha
oovar &g vvif cuion and that L•il(uc to soauc 03V,: c ... c zcctioa 25A of 1.(OL 152 n Imd to(ho imposdtoa of cnmm--J pcnnlbca
oomiuing of a fine of up to S 1X00,00 artdior impru,�of up to c«year and a�iJ pcaahio io dx fo(m of a Stop Work Ordcr and a
fim o(:S 100.00 i day a{unst me
~ For dcputnr.•,l ux orily
/ a
06
ECTION 8-CONSTRUCTION SERVICES
Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
� e .. . . Not Applicable
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10,WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance of the building permit.
ned Affidavit Attached Yes....... No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
pomeowner Signature
r
C S I e k l a livable
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Acce sory Bldg. Demolition❑ New Signs [ J Decks [ ] Siding[ ] Other [
J;()d a f i" n1o" I I
Brief Descn tion of roposed Work:
Alteration of existing edroom Yes No Adding new b�droom Yes No
g g
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
j
2..
a. Use of building : One Family Two Family Other
b. Nu er`of rooms in each family unit: Number of Bathrooms
c. Is there a ga?aattached?
d. Proposed Square footage-4af,new construction. Dimensions
e. Number of stories?
f. Method of heating? 4 Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. ""Ma,scheck Energy Compliance form attached?
Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction'-within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l as Owner of the subject property
hereby authorize �t to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner ', Date
as Owner/Authorized Agent
hereby declare that the statements and information on t regoing application are true and accurate, to the best of my
knowledge and belief.
I.SiRned under the pai af, aerjury.
Print e
S ignature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column filled in by
Building Department
ent
y rune 'Fo, �
Lot Size I�
Frontage
Setbacks Frontp
Side L: R: L:W R: �
Rear
Building Height
Bldg.Square Footage fgcc F % 9 ��
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: �--
(volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO '// DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO V
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES
No,
IF YES, describe size, type and location:
�A City of Northampton
w Building Department
A 212 Main Street
Room 100
Northarlipton, MA 01060
ph n"6`413.587.1240 Fax 413.587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: s se+r f rt� wo b oft""be cqmp
U
Cz
l ez o'L
E,[m st-'a Ar°ildt.... Cat 31s r,Ict�,,:.
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
J(-)��e 0914 2�/Xo veyr i G�
ame(Print) Current Mailing Address6z el/ 4
/
'r Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION`COSTS'
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building Maw-!o (a) Building Permit Fee
2. Electrical 0 Q o o (b),Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4+ 5) 00 Check Number
This Section For Official;,Use Onl
uilding Permit Number: B bvp t7 Rate Issued:
AO
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2000-0907
APPLICANT/CONTACT PERSON BRIN JOSEPH V JR&GABRIELE T
ADDRESS/PHONE 591 BURTS PIT RD (413)585-0761 O
PROPERTY LOCATION 591 BURTS PIT RD
MAP 29 PARCEL 478 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid ,3"OZ �S-
Typeof Construction: INSTALL 24'ABOVE GROUND POOL -
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE, LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
c/Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § _w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservati ommission Permit from CB Architecture Committee
20 2c tad
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
591 BURTS PIT RD
BP-2000-0907
GIs#: COMMONWEALTH OF MASSACHUSETTS
'' 4'Map:Block:29-478 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Categ_orv:Above ground pool BUILDING PERMIT
Permit# BP-2000-0907
Project# JS-2000-1676
Est.Cost: $200.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 7971 4.80 Owner: BRIN JOSEPH V JR&GABRIELE T
Zoning: SR Applicant: BRIN JOSEPH V JR & GABRIELE T
AT. 591 BURTS PIT RD
Applicant Address: Phone: Insurance:
591 BURTS PIT RD (413) 585-0761 ()
FLORENCEMA01062 ISSUED ON:4121100 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 24' ABOVE GROUND POOL
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
ON*` Building 4/21/00 0:00:00 501 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo